Healthy Checkout Ordinance in Berkeley, California, 2021‒2022: Impacts on Added Sugars, Sodium, and Other Nutrients at Checkout 1 Year After Implementation.

Objectives. To assess the impact of the world's first mandatory healthy checkout policy on added sugars, sodium, and other nutrients available at retail checkouts in Berkeley, California. Methods. We collected data on food and beverage facings before (2021) and after (2022) policy implementation in 23 Berkeley (8786 facings) and 75 California comparison stores (40 617 facings). Our analysis used difference-in-differences models. Results. Between 2021 and 2022, there was a 70% reduction in added sugars per serving of food and beverage facings (b = 0.30; 95% confidence interval [CI] = 0.15, 0.59) and a 53% reduction in sodium per serving of beverage facings (b = 0.47; 95% CI = 0.28, 0.81) at Berkeley checkouts relative to comparison city checkouts. There was a 41% reduction in saturated fat and a 47% increase in fiber per serving of food and beverage facings (b = 0.59; 95% CI = 0.44, 0.79 and b = 1.47; 95% CI = 1.05, 2.06, respectively). Conclusions. One year after implementation, the policy reduced added sugars and saturated fat per serving of food and beverage facings, reduced sodium per serving of beverage facings, and increased fiber per serving of food and beverage facings. Public Health Implications. Healthy checkout policies have potential to increase the healthfulness of checkout food environments. (Am J Public Health. Published online ahead of print August 14, 2025:e1-e13. https://doi.org/10.2105/AJPH.2025.308159).